| NPI | 1790244614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E15628) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C1-0027701) |
| 208000000X Pediatrics (Licence: NJ 25MA12467800) | |
| 208000000X Pediatrics (Licence: AR E-15628) | |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: DE C1-0027701) | |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NJ 25MA12467800) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-05-05 |